POS0567 SELF-PERCEIVED GENERAL HEALTH AT START OF ANTI-TNF THERAPY PREDICTS THERAPEUTIC RESPONSE IN PATIENTS WITH RHEUMATOID ARTHRITIS: ANALYSIS FROM THE CZECH BIOLOGICS REGISTRY ATTRA
Authors: J. Zavada, L. Nekvindova
Journal: Annals of the Rheumatic Diseases (2022)

Background SF-36 and its components, as well as other PROs have been shown to predict various disease outcomes. We hypothesized that positive responses to questions (Q) 11A “I seem to get sick a little easier than other people“, and 11C “I expect my health to get worse“ from the general health (GH) domain of the SF-36 v1 questionnaire may correspond to a more fragile self-perceived GH status, and thus serve as possible predictors of future disease outcomes in patients with rheumatoid arthritis (RA). Objectives We aimed to investigate whether these 2 questions could predict therapeutic response in patients with RA starting their first anti-TNF therapy. Methods We have used two separate datasets from the Czech biologics registry ATTRA to validate our hypothesis. Dataset D1 included RA patients with at least 1 year follow-up and all relevant data available starting their first-line anti-TNF treatment within period 01/01/2012-31/12/2017 (N=1808), and dataset D2 pts starting in in 01/01/2018–01/01/2020 (N=734). Our primary outcome was DAS28-ESR remission (REM) at 12 months. REM was defined as DAS28&lt;2.6. Patients were grouped according their response (definitely/mostly yes vs. definitely/mostly no) to Q11A and Q11C at baseline. REM rates after 12 months of 1st-line anti-TNF treatment were compared across patients‘ groups with Pearson chi-squared test. Firstly, odds ratios (ORs) using logistic regression (univariate, and then adjusted to baseline DAS28 and HAQ) were calculated to predict REM at 12M. Secondly, ORs were calculated after matching pts with positive or negative responses by a propensity score (PS) using sex, age, disease duration, baseline DAS28, calendar year and co-medication to balance baseline differences. Results At baseline, 79% and 80% pts were female, mean (SD) age was 52(12) and 54(13) years, DAS28 6.3 (0.9) and 6.2 (1.1), HAQ 1.5(0.6) and 1.5(0.6), 74% and 68% were RF+, 70% and 69% ACPA+ in D1 and D2 resp. In D1 34% and 31% pts, and in D2 32% and 30% responded positively to Q11A and 11C resp. Patients with positive responses to Q11A and 11C tended to have slightly (but statistically significantly) higher DAS28, HAQ, CRP or ESR, and patient- and physician global activity assessment at baseline. At 12 months, 40% (49%), 31% (37%), and 30% (40%) patients with positive, negative and neutral response to Q 11A reached REM; p&lt;0.001 (p=0.018) in D1 (D2) resp. At 12 months, 42% (51%), 31% (37%), and 30% (40%) patients with positive, negative and neutral response to Q 11C reached REM; p&lt;0.001 (p=0.04) in D1 (D2) resp. Crude and adjusted ORs for reaching REM according to responses to Q11A and Q11C are shown in the Table 1. Conclusion We provide a robust evidence that self-perceived general health at start of anti-TNF therapy predicts reaching remission at 12 months in pts with RA. Dataset D1 (N=1808) D2 (N=734) Baseline parameter OR (95% CI) p OR (95% CI) p Analysis 1: Patients‘ responses and occurrence of DAS28 remission after 12 months - Univariate logistic regression models (Remission (DAS28-ESR &lt; 2.6) after 12 months (1 – yes vs. 0 – no) Q11A: yes vs. no 1.62 (1.27; 2.05) &lt; 0.001 1.74 (1.20; 2.52) 0.004 Q11C: yes vs. no 1.48 (1.15; 1.91) 0.003 1.66 (1.13; 2.45) 0.010 Analysis 2: Patients‘ responses and occurrence of remission after 12 months - Adjusted ORs using logistic regression Q11A: yes vs. no 1.86 (1.24; 2.79) 0.003 2.04 (1.37; 3.03) &lt; 0.001 HAQ 0.48 (0.35; 0.64) &lt; 0.001 0.45 (0.33; 0.62) &lt; 0.001 DAS28-ESR 0.74 (0.61; 0.88) &lt; 0.001 0.89 (0.76; 1.05) 0.165 Q11C: yes vs. no 1.65 (1.28; 2.13) &lt; 0.001 1.91 (1.26; 2.88) 0.002 HAQ 0.59 (0.49; 0.71) &lt; 0.001 0.46 (0.34; 0.62) &lt; 0.001 DAS28-ESR 0.73 (0.64; 0.83) &lt; 0.001 0.91 (0.77; 1.06) 0.232 Analysis 3: Patients‘ responses and occurrence of remission after 12 months - Univariate logistic regression models after PS matching Q11A: yes vs. no 1.45 (1.12; 1.87) 0.004 1.70 (1.12; 2.59) 0.013 Q11C: yes vs. no 1.33 (1.00; 1.77) 0.050 1.51 (0.97; 2.34) 0.066 yes vs. no = definitely yes / mostly yes vs. definitely no / mostly no Acknowledgements This work was supported by the project (Ministry of Health, Czech Republic) for consensual development of research organization 023728 Disclosure of Interests Jakub Zavada Speakers bureau: Abbvie, Elli-Lilly, Sandoz, Novartis, Egis, UCB, Lucie Nekvindova: None declared.